Most of the data on diseases of the bowel concern younger individuals, and there is a paucity of information on the effects of aging on gastrointestinal symptoms and pathophysiology. Moreover, the effect of colonic disorders on functional status and well being is largely unexplored. Chronic idiopathic constipation and chronic abdominal pain associated with an abnormal bowel habit in the absence of organic disease (irritable bowel syndrome [IBS]) are common and important functional bowel diseases in the community. The pathogenesis of these disorders is unknown, although they may be accompanied by demonstrable pathophysiological abnormalities. The overall goals of this proposal are to determine the prevalence of chronic gastrointestinal symptoms (including constipation, diarrhea, and fecal incontinence) and functional bowel disease in the elderly, and to explore the pathogenesis and impact on quality of life of functional bowel disease. Specifically, we aim to assess the prevalence of individual gastrointestinal symptoms, as well as particular functional syndromes in a community, using a validated questionnaire. This phase will also address whether psychosocial factors influence which elderly persons with symptoms present to physicians (and which do not), and whether certain health habits (smoking, alcohol, analgesics) or medications (including laxatives or enemas) play a role. Based on this information, we will then identify subpopulations with well-characterized symptom clusters (chronic painless constipation, constipation-predominant IBS, diarrhea-predominant IBS). In these subgroups, we will test the hypotheses that the following, alone or in combination, are of relevance to pathogenesis: a) dietary factors (including fiber) and overall nutrition and b) colonic dysfunction as reflected by altered transit of orally nutrition and b) colonic dysfunction as reflected by altered transit of orally ingested markers and, in a random sample of those with chronic constipation and prolonged colonic transit, a new scintigraphic assessment. We will also test the hypothesis that psychological distress (including depression), lack of social support and poor coping strategies impact negatively on symptom severity and functional status. These approaches will be facilitated by interaction between Mayo's Rochester Epidemiology Project and the physiological expertise of the Gastroenterology Research Unit. This proposal should help elucidate the genesis and impact of these important, highly morbid conditions in the elderly.